Ebstein's Anomaly
What is it?
A malformed heart valve that does not properly close to keep the blood flow moving in the right direction. Blood may leak back from the lower to upper chambers on the right side of the heart. This syndrome also is commonly seen with an atrial septal defect, or ASD (or a hole in the wall dividing the two upper chambers of the heart).
More information for parents of children with Ebstein's anomaly
Can it be repaired?
Ebstein's anomaly is mild in many children that they don't need surgery. But sometimes the tricuspid valve leaks severely enough to result in heart failure or cyanosis. Then surgery may be required.
Several different operations have been used in patients with Ebstein's anomaly. The most common involves a repair of the tricuspid valve. The valve can't be made normal, but often surgery significantly reduces the amount of leaking. If there's an ASD, it's usually closed at the same time. In some cases the tricuspid valve can't be adequately repaired. Then it's replaced with an artificial valve.
What ongoing care will my child need?
Children with Ebstein's anomaly should receive continued care from a pediatric cardiologist. Besides getting information from routine exams, the cardiologist may use tests such as electrocardiograms, Holter monitor and echocardiograms.
What activities will my child be able to do?
If valve leakage is mild and tests show no abnormal heart rhythms, your child can usually participate in most sports. Your cardiologist may recommend avoiding certain intense competitive sports. Ask your child's cardiologist which activities are appropriate.
What problems might my child have?
Children with Ebstein's anomaly may have a rapid heart rhythm called supraventricular tachycardia (SVT) often as a result of a condition called Wolff-Parkinson-White syndrome (WPW). An episode of SVT may cause palpitations (older children may feel your heart racing). Sometimes this is associated with fainting, dizziness, lightheadedness or chest discomfort. Infants may be unusually fussy or have other symptoms that can't easily be connected with rapid heart rhythm. If you child has had these symptoms, contact your doctor. If your symptoms persist, seek immediate attention. Recurrent SVT may be prevented with medicines. In many cases, the source of the abnormal heart rhythm may be removed by a catheter procedure called radiofrequency ablation.
If the valve abnormality is especially severe, you may have decreased stamina, fatigue, cyanosis, and sometimes fluid retention. Infants may not feed or grow normally. The symptoms may respond to medicines such as diuretics. In some instances surgery (described above) may be recommended.
What about preventing endocarditis?
People with unrepaired or incompletely repaired are at risk for endocarditis. Ask your pediatric cardiologist about your child's need to take antibiotics before certain dental procedures to help prevent endocarditis. See the section on Endocarditis for more information.
Congenital Heart Defect ID sheet
More information for adults with Ebstein's anomaly
What causes it?
Most cases don't have an identifiable cause. Some studies have found an association between mothers on lithium (a mood stabilizing medication) and their children having Ebstein's anomaly. More recent studies suggest this isn't the case. Currently, pregnant woman on lithium are usually referred for fetal echocardiography to assess for Ebstein's anomaly in the fetus.
How does it affect my heart
Because the tricuspid valve is malformed in Ebstein's anomaly, it often doesn't work properly and may leak. If the valve leaks, some of the blood pumped by the right ventricle goes backwards through the valve with each heartbeat. This may result in significant enlargement of the right atrium. In more extreme cases the size of the right ventricle is too small to allow for enough blood to go to the lungs.
How does it affect me?
If the leakage of the tricuspid valve is moderate or severe, symptoms including exercise intolerance and swelling of the abdomen and legs may develop. Heart rhythm problems may also occur. In extreme cases when the right ventricle is underformed, babies may be very blue. In these cases, patients may have required surgeries similar to patients with single ventricles.
Surgery in childhood and adulthood
Ebstein's anomaly is mild in most adults who have it, so they don't need surgery. But sometimes the tricuspid valve leaks severely enough to result in heart failure or cyanosis. Then surgery may be required. Several different operations have been used in patients with Ebstein's anomaly. The most common involves a repair of the tricuspid valve. The valve can't be made normal, but often surgery significantly reduces the amount of leaking. In some cases the tricuspid valve can't be adequately repaired. Then it's replaced with an artificial valve. If there's an ASD, it's usually closed at the same time. In some patients, the atrial septal defect is the main problem and can be closed either with a device or with surgery.
Problems You May Have
Heart Rhythm Disturbances
People with Ebstein's anomaly may have a rapid heart rhythm called supraventricular tachycardia (SVT). An episode of SVT may cause palpitations. (You feel your heart racing.) Sometimes this is associated with fainting, dizziness, lightheadedness or chest discomfort. If you have these symptoms, contact your doctor. If your symptoms persist, seek immediate attention. Recurrent SVT may be prevented with medicines. In many cases, the source of the abnormal heart rhythm may be treated by a catheter procedure called radiofrequency ablation. See the Arrhythmias section for more information.
Other Problems
If the valve abnormality is especially severe, you may have decreased stamina, fatigue, cyanosis and sometimes fluid retention. These problems usually develop because the valve has become leakier. If you have these symptoms, contact your cardiologist. The symptoms may respond to medicines such as diuretics, which cause you to lose excess fluid. In some instances surgery (described above) may be recommended.
Ongoing Care
What will I need in the future?
People with Ebstein's anomaly should receive continued care from a cardiologist with expertise in congenital heart defects. You should also consult a cardiologist with expertise in care of adult congenital heart disease if you're undergoing any type of non-heart surgery or invasive procedure.
Medical
Besides getting information from routine exams, the cardiologist may use tests such as electrocardiograms, Holter monitor and echocardiograms.
Activity Restrictions
Being physically active is good for your cardiovascular system, so stay active. See the Physical Activity section for more information. If valve leakage is mild and tests show no abnormal heart rhythms, you can usually participate in most sports. Your cardiologist may recommend avoiding certain intense competitive sports. Ask your cardiologist which activities are right for you.
Endocarditis Prevention
You may need antibiotics before certain dental or surgical procedures to prevent endocarditis if you are cyanotic (blue) or have a prosthetic valve. See the section on Endocarditis for more information.
Pregnancy
Pregnancy puts many increased demands on the heart. In most cases women with mild Ebstein's anomaly will be able to safely deliver a baby. Still, each woman should be evaluated individually. Consult with your cardiologist about the safety of pregnancy. See the section on Pregnancy for more information.
Will you need more surgery?
Patients with mild tricuspid valve leakage are unlikely to require surgery at any point. Patients with more moderate or severe leakage may need initial or subsequent surgery. Patients who have undergone pacemaker placement need close follow-up and eventually may need their pacemaker replaced.
